Diabetes Mellitus and Diabetic Retinopathy
Diabetic retinopathy is the alteration of the retina generated by diabetes mellitus. This disease is increasing in the number of people affected by it worldwide and an estimated 415 million adults have diabetes at the present time. The increase in diabetes will have consequences with a significant increase in cases of diabetic retinopathy.
According to the OMS definition, diabetes is a metabolic disease characterized by an increase in glycemia and by microvascular and cardiovascular complications that substantially increase the morbidity and mortality associated with the disease by reducing the quality of life. Diabetes complications are classified In microangiopathies (retinopathy, nephropathy and diabetic neuropathy) and macroangiopathic (atheromatosis).
At the ocular level causes the appearance of diabetic retinopathy, which consists of an alteration of the blood vessels of the retina, with altered visual function. The causes are increased glucose (hyperglycemia), but other factors also influence such as hypertension, dyslipidemia, hemorrhagic changes and genetic load of the patient.
The prevalence of diabetic retinopathy increases with the duration of diabetes, with an overall rate of up to 30% and a prevalence with vision threat of 10% of the diabetic population. Diabetic retinopathy is the leading cause of legal blindness in patients between 25 and 50 years of age in industrialized countries, affecting approximately 7.5% of diabetics, with diabetic macular edema being the most frequent cause of vision loss.
Among the factors that determine or influence the occurrence of diabetic retinopathy among diabetics there are no modifiable factors such as type of diabetes (I or II), duration of diabetes (the time of evolution of the disease is the main Risk factor, the longer the duration of diabetes, the greater the prevalence of diabetic retinopathy. After 20 years of diagnosis of diabetes, practically 100% of patients with type 1 diabetes and 60% of patients With type 2 diabetes, it is rare to find signs of RD in type 1 diabetes before 2-5 years of diagnosis. However, in type 2 diabetes, varying degrees of RD can be observed at the time of diagnosis because in This type of diabetes is difficult to establish accurately the time of onset of the disease) and the genetic load of the subject. On these factors we can not act.
On the other hand other factors that influence its development, if they are modifiable and therefore we must act on them as they are the glucose level. The diabetic should have glycosylated hemoglobin in 7%; The metabolic control of the disease is crucial to decrease the progression of RD. Thus, optimization of glycemic control reduces the risk of RD and consequently, loss of vision. The diabetic patient should try to maintain stable blood glucose levels avoiding hyperglycaemia and hypoglycemia. You should periodically analyze your blood glucose level and do every 6 months glycosylated hemoglobin controls that will give you glycemic control information for the past 6 months.
High blood pressure is also a known risk factor in the progression of RD. It is advised that systolic blood pressure should be kept below 130 mm Hg and diastolic blood pressure below 80 mm Hg. Dyslipemia has also been described as a factor favoring RD although the results are not completely conclusive.
Monitoring and control of these factors, as well as the progression of diabetic retinopathy itself, is an indispensable measure to avoid loss of vision. Early diagnosis is the best strategy to prevent or delay vision loss. Throughout the periodic examination of the fundus of all diabetic patients it is recommended to prevent and treat retinal lesions early before there is loss of visual acuity.
Finally, the importance of early and coordinated treatment among family physicians, endocrinologists and ophthalmologists should be highlighted. Interprofessional collaboration for the prevention and early treatment of RD is a clear benefit to the patient’s quality of life.